Table 2 Differential diagnosis of obstetric acute heart failure
From: Preeclamptic heart failure — perioperative concerns and management: a narrative review
Diagnosis | Clinical presentation | Role of echocardiography |
|---|---|---|
Acute coronary syndrome | • Typical chest pain with localizing ECG changes • Arrhythmias, heart block • Elevated troponin levels | • Identification of regional wall motion abnormalities • Detect complications of myocardial infarction: acute mitral regurgitation, ventricular septal rupture, ventricular wall rupture, and cardiac tamponade |
Arrhythmias | • Palpitations • Syncopal attacks | • Could help rule out structural defects predisposing to arrhythmias (e.g., valvular disease) • Rule out the presence of thrombus in heart chambers |
Valvulopathies | • Worsening of preexisting symptoms in known heart disease patients • New onset dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and palpitations | • Detect structural valvular/septal defects • Pulmonary arterial hypertension • Chamber enlargement • Rule out intracardiac thrombi |
Preeclampsia | • New-onset hypertension after 20 weeks’ gestation associated with proteinuria, adverse conditions, or multi-organ dysfunction | • Identify and grade LV concentric hypertrophy • Detect and quantify LV systolic and diastolic dysfunction |
Peripartum cardiomyopathy | • HF toward the end of pregnancy or postpartum • Diagnosis of exclusion • Elevated natriuretic peptide levels | • LV systolic dysfunction and ejection faction < 45% • Global hypokinesia |
Takotsubo cardiomyopathy | • Ischemic-like chest pain and transient ECG changes • Elevated troponin level | • Identify characteristic apical ballooning with free wall-sparing |
Septic cardiomyopathy | • Systemic features of sepsis • Hypo/hyperthermia • Hypotension • Raised inflammatory markers | • Demonstrate global hypokinesia with a hyperdynamic circulation |